Makindo Medical Notes

💪 Even if reduced, patients are often admitted for elevation and regular neurovascular checks (circulation, sensation, movement) due to the high risk of swelling-related neurological deficit.

📖 Introduction

• Elbow dislocation is a common joint injury, most often from trauma (e.g., FOOSH, sports, or high-energy accidents).
• It involves displacement of the ulna and radius from articulation with the humerus.
• Early recognition and treatment are vital to prevent complications such as neurovascular injury, stiffness, and long-term instability.

⚡ Causes

• Fall on an outstretched hand (FOOSH injury)
• Direct blow or trauma to the elbow
• Sports injuries (e.g., rugby, gymnastics, wrestling)
• Motor vehicle accidents
• High-energy trauma in younger individuals

🩺 Clinical Features

• Gross deformity: loss of the normal “triangle” (olecranon + epicondyles).
• Severe pain, swelling, and reduced/eliminated range of motion.
• Assess and document neurovascular status carefully:
• Median Nerve:
  • Motor ➝ thumb opposition, MCP flexion
  • Sensory ➝ radial border of index finger
• Radial Nerve:
  • Motor ➝ wrist extension
  • Sensory ➝ dorsum of hand, radial aspect
• Ulnar Nerve:
  • Motor ➝ finger ab/adduction (MCP joints)
  • Sensory ➝ ulnar border of little finger
• Assess distal pulses (brachial, radial) ➝ document circulation.
• Give IV access + IV analgesia (e.g., morphine) before imaging.
• Immobilise in a broad-arm sling before reduction.

🩻 X-Ray Findings

• Request AP + lateral elbow X-ray.
• Most dislocations are posterior.
• Check for associated fractures ➝ especially radial head/neck and coronoid process.
• Fracture-dislocation: 🚫 Do NOT attempt reduction in ED — refer to orthopaedics (risk of bone fragment entrapment).

🛠️ Management

• Transfer to resus; apply monitoring.
• Consent for procedural sedation; ensure 2 doctors are present.
• Reduce with longitudinal traction + gentle flexion.
• Reassess and document neurovascular status post-reduction ✅.
• Apply a long-arm backslab before post-reduction X-ray (joints often unstable).
• Obtain a post-reduction X-ray.
• Refer to on-call orthopaedics.

⚠️ Complications

• Neurovascular injury (esp. median & ulnar nerve, brachial artery).
• Associated fractures ➝ “terrible triad” (radial head + coronoid + dislocation).
• Compartment syndrome.
• Chronic instability, stiffness, heterotopic ossification.

📅 Follow-up & Rehab

• Ortho follow-up in fracture/dislocation clinic.
• Physiotherapy ➝ early, supervised mobilisation prevents stiffness.
• Most patients recover well, but some may develop chronic instability or restricted extension.